HomeMy WebLinkAboutCon Con Amendment 10Today's Date
11/17/2022
Fund/Department
116 -Public Health
Kittitas County
Review Form
Grants & Contract Agreement
�PA Camas Request #:
Agenda Date:
Contract/Grant Information
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Contract /Grant Agency: Consolidated Contract Amendment 10
Period Begin Date: 01.01.2022 Period End Date: 12.31.2024
Total Grant/Contract Amount: Increase of $32,977.00 for a revised maximum consideration of
$3,706,366.00
Grant/Contract Number: CHL31015
Contract/Grant Summary:
The Consolidated Contract Amendment 10 Amends Statements of Work for the following programs:
Adds Statement of Work for the following program:
r COVIC 19 LHJ Vaccination-AR PA- Effective November 1, 2022
Exhibit B-10 Allocations, attached and incorporated by this reference, amends, and replaced Exhibit B-8
Allocation as follows:
0 Increase of $32,977.00 for a revised maximum consideration for $3,706,366.00
Recommendation for Board of Health Review on
Department Head Signature:
Director Date:
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
Signature of Prosecutor's Office Date
Signature of Auditor's Office
Date
Verification the Contracting Agency is not Suspended/Disbarred:
Grant/Contract Review Page 1
® Agency is not suspended/disbarred ❑ Not Checked (reason)
Financial Information
Total Amount $20,940
State Funds $
Federal Funds $
Percentage County Funds 100%
Matching Funds $
CFDA#
In -Kind $
Explain
Is Equipment being purchased? No
Who owns equipment? Cannon Solutions
New Personnel being hired? No
Contact HR hiring — reporting requirements
Future impacts or liability to Kittitas County:
Budget Intormation
Budget Amendment Needed? Yes ❑ attach budget form No ® why not
New Division Created? I Already Budgeted
Revenue Code 116.612.39.28.333.21.027
Expense Code 612.39.28.51001 / 52001 / 50098
Pass Through Information
Agency to Pass Through
Amount to Pass Through Expense Code:
Sub -Contract Approved Date:
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes El No ❑
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
BOCC Approval Needed?
Yes ❑ No FXI
Staff Member Presenting:
Assignment or i racKing inrormation
Auditor's Office
Human Resource
Grant/Contract Review Page 2
Prosecutor's Office
Who Signed the grant application
I Reviewer I Date I
Grant/Contract Review Page 3
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT
2022-2024 CONSOLIDATED CONTRACT
CONTRACT NUMBER: CLH31015
AMENDMENT NUMBER: 10
PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as
"DOH", and KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT, a Local Health Jurisdiction, hereinafter referred
to as "LHJ", pursuant to the Modifications/Waivers clause, and to make necessary changes within the scope of this
contract and any subsequent amendments thereto.
IT IS MUTUALLY AGREED: That the contract is hereby amended as follows:
1. Exhibit A Statements of Work, includes the following statements of work, which are incorporated by this reference
and located on the DOH Finance SharePoint site in the Upload Center at the following URL:
htt s:llstate fwa.shar int.c misit doh-ofsf indin res urces/site a eslhonic.as x?=e I :9a94fi$ da2d9 3ea Oac fbc32e4d7c
® Adds Statements of Work for the following programs:
COVID-19 LHJ Vaccination-ARPA - Effective November 1, 2022
❑ Amends Statements of Work for the following programs:
❑ Deletes Statements of Work for the following programs:
2. Exhibit B-10 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B-9 Allocations
as follows:
® Increase of3$ 2,977 for a revised maximum consideration of $3,706,366.
❑ Decrease of for a revised maximum consideration of
❑ No change in the maximum consideration of .
Exhibit B Allocations are attached only for informational purposes.
Unless designated otherwise herein, the effective date of this amendment is the date of execution.
ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force
and effect.
IN WITNESS WHEREOF, the undersigned has affixed his/her signature in execution thereof.
KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT STATE OF WASHINGTON
DEPARTMENT OF HEALTH
Signature: Signature:
Date: rat
APPROVED AS TO FORM ONLY
Assistant Attorney General
Page 1 of 1
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